Andrology on the Internet: Most wanted, controversial and often primary source of information for patients

[Patient events in German urology: trend towards hybrid formats?]

BACKGROUND

Patient events are an important tool to respond to the increasing need of the public for health information. Through the "patient forum", the German Society of Urology (DGU) is committed to patient information and public relations at its annual congresses. The goal of the study was to evaluate the events from 2017-2019 and to compare them with the first digital patient forum in 2020.

MATERIALS AND METHODS

Using a two-page standardized questionnaire, we surveyed the visitors of the presence patient forums (presence group = P) of the three annual congresses of the DGU 2017-2019 as well as the users of the digital event 2020 (online group = O).

RESULTS

We obtained 71 records for 2017-2019 and 18 for 2020. The median age of visitors was 64 years (range 30-89). Males were 66% (P) vs. 83% (O) of participants (p = 0.005). The offer was rated overall as good to very good by both groups, i.e., 1.6 (P) vs. 1.6 (O; p = 0.7) on a scale from 1 to 6 with 1 being the highest rating. In line with the lower interaction in the digital format, the possibility to ask questions was rated worse with 1.5 (P) vs. 2.8 (O; p = 0.003). When asked about the desired future event format, two-thirds of the users of the digital patient forum were in favor of a hybrid event on-site and online.

CONCLUSION

Patient events are suitable means of communication for the public and are rated well by visitors. In particular, interaction with experts is highly valued. Face-to-face formats are associated with a high logistical effort and high costs, and their reach is limited. In the future, hybrid formats could be a reasonable alternative, as they combine the advantages of online and face-to-face formats.

Online Symptom Checkers are Poor Tools for Diagnosing Men's Health Conditions

OBJECTIVE

To analyze the accuracy of the four most commonly used online symptom checkers (OSCs) in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT).

METHODS AND OUTCOMES

One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). The vignettes were entered into the 4 most frequently used OSCs (WebMD, MedicineNet, EverydayHealth, and SutterHealth) as determined by web traffic analysis tools. The top 5 conditions listed in the OSC differential diagnosis were recorded and scored.

RESULTS

WebMD's accuracy for ED, SP, PD, and LT vignettes was 0%, 22.5%, 0%, and 95%, respectively. EverydayHealth was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions. MedicineNet diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of vignettes, respectively. SutterHealth correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively. Cumulatively, the OSCs were most accurate in diagnosing ED and least accurate in diagnosing SP when using the Top 1 (37.5% vs. 6.9%) and Top 5 (50% vs. 24.5%) of the suggested conditions.

CONCLUSIONS

No OSC could accurately diagnose all the conditions tested. The OSCs, on average, were poor at suggesting precise diagnoses for ED, PD, LT, SP. Patients and practitioners should be cautioned regarding the accuracy of OSCs.

Paramedical counselling in infertility treatment: its effects on anxio-depressive symptom severity, perceived stress and self-esteem

Aims

The importance of contributing psychological factors and stress-control in female infertility is well documented, but research on their role in male infertility is scarce. The present study aimed to evaluate the effects of a novel paramedical counselling on anxio-depressive symptom severity, perceived stress and self-esteem in infertile men participating in an infertility treatment programme.

Methods

Patients were recruited from clinics of University of Szeged, Hungary between 2019 May and 2020 December, and were sorted into control (n = 51) and experimental (n = 57) groups, where patients in the experimental group received a 5-session paramedical counselling in extension to their medical treatment. The levels of anxio-depressive symptom severity, perceived stress and self-esteem were measured prior to and after receiving paramedical counselling. The control group scored lower in regards of the severity of depressive symptom, and showed an increase of self-esteem, while the experimental group resulted in a significant decrease of anxio-depressive scores with the elevation of the level of self-esteem.

Results

Our results indicate that joining an infertility treatment programme alone had a positive role in reducing depressive symptoms and in the increase of self-esteem among infertile men, but receiving additional paramedical counselling throughout the treatment programme resulted in the decrease of anxio-depressive symptoms, besides the elevation of the level of self-esteem, with a significantly higher decrease in the state anxiety compared to not receiving this additional paramedical counselling.

Conclusions

Thus, it would be advisable for infertility treatment programmes to incorporate screening for psychological vulnerability and implement additional paramedical counselling to alleviate these confounding symptoms detrimental to conceiving.

The Treatment Decision-making Preferences of Patients with Prostate Cancer Should Be Recorded in Research and Clinical Routine: a Pooled Analysis of Four Survey Studies with 7169 Patients

Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.

"OMG, Yes!": Feasibility, Acceptability, and Preliminary Efficacy of an Online Intervention for Female Sexual Pleasure

The purpose of this study was to evaluate the acceptability, feasibility, and preliminary efficacy of using an online educational resource that presents research-informed strategies for women's pleasure, OMGyes.com, as a resource to empower women to broaden the ways in which they understand, advocate for, and enjoy sexual pleasure. A cohort of 870 adult women was given access to OMGyes.com and asked to explore the resource over a four-week period and complete online pre/post questionnaires. Participants reported a high level of satisfaction with the relatability, usefulness, and functionality of OMGyes.com. We observed statistically significant, large effect size increases in participants' knowledge about their own pleasure preferences, their confidence and positivity about that knowledge, as well as how pleasurable their sexual experiences were during both masturbation and partner sex. Many participants reported that after using OMGyes.com they felt more motivated to explore their preferences and more confident to explain their preferences to their partners. Our data suggest that OMGyes.com may be useful for positively impacting how women think about sexual pleasure, how they understand their own specific preferences, how they advocate for what they enjoy with partners, and how they actually experience pleasure.

Treatment of post-prostatectomy urinary incontinence and erectile dysfunction: there is insufficient utilisation of care in German cancer survivors

PURPOSE

Treatment of post-prostatectomy urinary incontinence (UI) and erectile dysfunction (ED) increases quality of life (QoL). Aim of our study was to evaluate the utilisation of care among patients with post-prostatectomy UI and ED in Germany.

METHODS

The HAROW study documented treatment of patients with localised prostate cancer (≤ T2c) in Germany. 1260 patients underwent radical prostatectomy (RP). Patients answered validated questionnaires after a median follow-up of 6.3 years. Response rate was 76.8%.

RESULTS

Median age at RP was 65 (IQR 60-69) years. 14% (134/936) used more than one pad per day for UI. 25% (26/104, 30 missing) of UI patients underwent surgery to improve continence. Of patients without surgery, 41% (31/75) reported a moderate-to-severe issue concerning their incontinence with worse mental health and QoL. 81% (755/936) patients were unable to have an erection firm enough for sexual intercourse. Of all ED patients, 40% (319/793) used ED treatment regularly or tried it at least once. 49% (243/499) of patients with interest in sex never tried ED treatment. In multivariate analysis, patients not using ED treatments were older (≥ 70 years OR 4.1), and more often had preoperative ED (OR 2.3) and less interest in sex (OR 2.2). Nevertheless, 30% (73/240) of these patients had moderate-to-severe issues with their ED reporting worse mental health and QoL.

CONCLUSION

Almost half of the patients without post-prostatectomy UI and ED treatment reported moderate-to-severe issues with a significant decrease in QoL. This indicates an insufficient utilisation of care in Germany.

Correlation between Twitter mentions and academic citations in sexual medicine journals

Social media services, especially Twitter, are used as a commonly sharing tool in the scientific world. This widespread use of Twitter would be an effective method in spreading academic publications. So, we aimed to investigate the relationship between Twitter mentions and traditional citations of articles in sexual medicine journals in this study. We reviewed the articles published in seven journals of sexual medicine (2 years after the publication of the articles) between January 2018 and June 2018. In the first half of 2018, 410 articles were extracted. Of these, 352 (85.9%) were original articles, while 58 (14.1%) were review articles. The median number of citations of the articles mentioned at least once on Twitter was 7 (interquartile range: 0-111) for Google Scholar, whereas it was 0 (interquartile range: 0-63) for Scopus, respectively. It was 4 (interquartile range: 0-25) for Google Scholar and 0 (interquartile range: 0-7) for Scopus. The publications mentioned on Twitter were cited more than the non-mentioned publications in the traditional-based citation system (p < 0.001). A significant relationship between the citation numbers and tweet numbers was also observed (p < 0.001). Also, in the linear regression model, the tweet numbers (p < 0.001) and article types (p < 0.001) were found to be related to the Google Scholar citation numbers. In conclusion, using Twitter as a professional tool in academic life would allow information to be propagated and responded quickly, especially for sexual medicine journals.

[Health care reality of urological endoprosthetics in Germany from 2006 to 2016]

Hintergrund

Die Behandlung von Harninkontinenz und erektiler Dysfunktion verbessert die Lebensqualität vieler Patienten. Insbesondere die Endoprothetik mit Sphinkter- und Penisprothesen erzielt hierbei sehr gute Ergebnisse, wenn konservative Therapieoptionen ausgeschöpft sind. Ziel dieser Studie ist eine Darstellung der Entwicklung und aktuellen Versorgungslage der Sphinkter- und Penisprothesenimplantation in Deutschland.

Material und Methoden

Wir führten eine Analyse der Diagnosis-Related-Groups-Abrechnungsdaten in Deutschland im Zeitraum von 2006 bis 2016 durch. Die Versorgungslage im Jahr 2016 beschrieben wir auf Basis der Qualitätsberichtsdaten der deutschen Krankenhäuser.

Ergebnisse

Von 2006 bis 2012 stieg die Zahl der implantierten Sphinkterprothesen in Deutschland von 739 auf 1112 (p < 0,001) und die Zahl der implantierenden Kliniken von 129 auf 206 (p < 0,001). Von 2012 bis 2016 fielen die Fallzahlen auf 980 und die Zahl der Kliniken auf 198. Im Jahr 2016 implantierten 168 (88 %) urologische Kliniken 1–9 Sphinkterprothesen und 23 (12 %) Kliniken ≥ 10 Sphinkterprothesen. Die 10 Top-Kliniken (≥20 Sphinkter) implantierten 34 % (283/839) aller Sphinkter. Von 2006 bis 2013 stieg die Zahl der implantierten Penisprothesen kontinuierlich von 263 auf 503 (p < 0,001) sowie die Zahl der implantierenden Kliniken von 71 auf 107 (p < 0,001). Von 2013 bis 2016 stagnierte die Fallzahl (p = 0,9) und die Zahl der implantierenden Kliniken (p = 0,5). Der Anteil implantierter Penisprothesen im Rahmen von Geschlechtsumwandlungen stieg von 17 % im Jahr 2006 auf 25 % im Jahr 2016 (p = 0,03). Im Jahr 2016 implantierten 83 (85 %) urologische Kliniken 1–6 Penisprothesen und 14 (15 %) Kliniken ≥ 7 Prothesen. Die 7 Top-Kliniken (≥20 Prothesen/Jahr) implantierten 232/448 (52 %) der Prothesen.

Diskussion

Der Versorgungsstand der urologischen Endoprothetik in Deutschland zeigt eine deutliche Zentrenbildung, aber auch eine große Zahl von Kliniken mit geringer Fallzahl. Seit 2012/2013 zeigt sich eine Stagnation der Fallzahlen von Penis- und Sphinkterprothesenimplantationen, die in Zusammenschau mit den Prostatektomiefallzahlen eine Unterversorgung vermuten lässt.

Zusatzmaterial online

Die Online-Version dieses Artikels (10.1007/s00120-021-01444-5) enthält weitere Tabellen zu Fallzahlen von Sphinkterprothesen und Penisprothesenimplantationen. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

E-Sexual Health: A Position Statement of the European Society for Sexual Medicine

BACKGROUND

Opportunities and pitfalls of e-health have been described and assessed in various health domains, but in the field of sexual health, the respective literature is limited.

AIM

The aim of this document is to present the European Society of Sexual Medicine's (ESSM) current position statement on e-sexual health.

METHODS

This statement article is an expert opinion-based proposal that was developed under the auspices of the ESSM with input from the e-sexual health subcommittee of the ESSM Scientific Committee.

OUTCOMES

ESSM statements were provided on four domains: health information for patients, e-learning for professionals, health interventions, and health research.

RESULTS

e-Sexual health is the use of information and communication technologies for sexual health including sexual health care, surveillance, education, knowledge, and research. Quality indicators have to be applied on Web pages that provide sexual health information, e-learning can increase educational opportunities for professionals, online treatment interventions can be effective but needs to be available to the public, and online health research can provide access to difficult to reach populations.

CLINICAL IMPLICATIONS

The ESSM acknowledges the necessity for the use of information and communication technologies to meet the sexual health needs of citizens and patients and also the professional needs of sexual healthcare providers, in an evidence-based manner.

STRENGTHS & LIMITATIONS

ESSM statements on this topic were provided based on expert opinion and summarize the ESSM position in this field.

CONCLUSION

The ESSM believes that e-sexual health can provide opportunities for the improvement of the sexual health of the population. Kirana PS, Gudeloglu A, Sansone A, et al. E-Sexual Health: A Position Statement of the European Society for Sexual Medicine. J Sex Med 2020;17;1246-1253.

Quality and availability of information in primary healthcare: the patient perspective

Objective: To explore lived experiences of patients communicating with and receiving information from primary health care.Design: Qualitative study analysing transcribed interviews by descriptive content analysis.Setting: Recruitment and interviews took place in southern Sweden in three primary care centres where privacy and undisturbed interview environments was ensured.Subjects: 17 primary care patient informants, 9 men and 8 women aged 31 - 84 years with varying educational levels from primary school to post graduates.Main outcome measures: Thematic categories and subcategories reporting the lived experience of the patients.Results: The analysis yielded three categories and identified as a main theme a feeling of unpredictability based on the emotional aspects of feeling lost and vulnerable when trying to access primary care. The category" Need for easy access" illustrated emotional aspects of importance to patients when contacting primary health care." Need for individual adaptation" described the need to individually adapt health related information." Information exchange" comprised experiences of information evaluation and understanding new information.Conclusions: Patients generally trusted the information received, but experienced a lack of communication, which evoked feelings of unpredictability and abandonment. Experiences of limited access to primary health care and the need for varying degrees of adaptation on the part of the individual were factors of concern for how patients experienced the care.Key PointsSmooth communication and understandable information are fundamental for quality primary health care. This qualitative interview study identified the following key points from analysing the views of 17 patients:• Patients indicated a feeling of unpredictability due to lack of access to and communication with health professionals.• Patients sometimes reported an inability to understand information conveyed by health professionals.• Being able to form relationships with health professionals was crucial for patients' trust and understanding.

A review of the evolving landscape between the consumer Internet and men's health

Internet adoption continues to increase as broadband access and mobile connectivity penetrate developing global markets. Alongside increasing adoption, the Internet continues to evolve and usher in new modes of user interaction. Social media and search engines have facilitated the emergence of the participatory web, in which users are able to contribute content, form online communities, and disseminate information. This participatory web is reshaping the patient-physician relationship as patients are able to search for medical information, directly engage with healthcare practitioners through social media, and make therapeutic decisions via online marketplaces. The ability for patients to self-diagnose and self-treat is highly relevant to andrology, given that men have a baseline reluctance to visit healthcare providers. Furthermore, men’s health issues such as erectile dysfunction and male infertility are stigmatized, with men turning to the Internet for guidance. The focus of this review is to survey the academic literature that evaluates the quality of online content for four common men’s health conditions: hypogonadism, male infertility, erectile dysfunction, and Peyronie’s disease.

Mapping the landscape of urology: A new media-based cross-sectional analysis of public versus academic interest

OBJECTIVES

To quantify public and academic interest in the urological field using a novel new media-based methodology.

METHODS

We systematically measured public and academic interest in 56 urological keywords and combined in nine subspecialties. Public interest was quantified as video views on YouTube. Academic interest was quantified as article citations using Microsoft Academic Search. The public-to-academic interest ratio was calculated for a comparison of subspecialties as well as for diseases and treatments.

RESULTS

For the selected 56 urological keywords, we found 226 617 591 video views on YouTube and 2 146 287 citations in the academic literature. The public-to-academic interest ratio was highest for the subspecialties robotic urology (ratio 6.3) and andrological urology (ratio 4.6). Prostate cancer was the central urological disease combining both a high public (20% of all video views) and academic interest (26% of all citations, ratio 0.8). Further diseases/treatments of high public interest were premature ejaculation (ratio 54.4), testicular cancer (ratio 11.4), erectile dysfunction (ratio 5.5) and kidney transplant (ratio 3.7). Urological treatments had a higher public-to-academic interest ratio (median ratio 0.25) than diseases (median ratio 0.05; P = 0.029).

CONCLUSIONS

A quantification of academic and public interest in the urological field is feasible using a novel new media-based methodology. We found several mismatches in public versus academic interest in urological diseases and treatments, which has implications for research strategies, conference planning and patient information projects. Regular re-assessments of the public and academic interest landscape can contribute to detecting and proving trends in the field of urology.